Clinical analysis of patients with moyamoya disease complicating hyperthyroidism

Objective To investigate the clinical features,pathogenesis and the effect of surgical and medical treatment of patients with moyamoya disease complicating hyperthyroidism.Methods The clinical data of 11 patients with moyamoya disease complicating hyperthyroidism were analyzed retrospectively,10 of them were diagnosed by digital substraction angiography(DSA),and 1 was diagnosed by magnetic resonance angiography.All the patients met the diagnostic criteria of hyperthyroidism.After controlling hyperthyroidism,8 patients underwent encephalo-duro-arterio-synangiosis,the other 3 were only given drugs to control hyperthyroidism.Results ①Ten of the 11 patients(8 females) showed thyroid dysfunction.with increased 3,5,3'-triiodothyronine(T3) and thyroxine(T4),and the decreased thyroid stimulating hormone(TSH).②Nine of the 11 patients showed cerebral infarction,1 showed intraventricular hemorrhage and 1 did not found any abnormality in imaging findings.Ten patients had bilateral lesions and 1 had unilateral lesions.③Eleven patients were followed-up for 11-102 months.Except 1 patient left mental decline and slow reaction,the symptoms of others were relieved or disappeared after the treatment.After encephalo-duro-arterio-synangiosis,8 patients did not have any surgical complications,6 of them conducted postoperative angiography(10-26 months) and all showed a great deal of compensatory blood supply from extracranial to intracranial arteries.Conclusion Moyamoya disease complicating hyperthyroidism is mostly occured in female patients and their clinical symptoms are mainly cerebral infarction.The pathogenesis of moyamoya disease complicating hyperthyroidism remains unclear.It may be associated with a variety of genetic and immune factors.After controlling hyperthyroidism,surgical treatment can establish effective collateral circulation and reduce the risk of recurrence of stroke.